What Price Medicine?

Last week I had the privilege of attending the American Physical Society Texas Section's annual regional meeting, held this year at the campus of the University of Texas at Dallas.  Among several invited speakers was a professor of radiology who spoke about the latest medical imaging techniques being developed for observing biological activity on the molecular level. 

As interesting as that was, I want to focus on an offhand remark the speaker made.  He has many friends in the medical research community, among whom is one who has been doing cancer research with rodents.  His friend has found that if rodents who have cancer are fed ordinary bicarbonate of soda (the same kind you can get in the Arm & Hammer box at the grocery store), the alkalinity it adds to the animal's body chemistry is enough to stop the cancer from metastasizing. 

That's not what I want to focus on either.  What I want to highlight is what the professor of radiology said next about his friend's discovery:  "It's too bad in a way, because, you know, there's no money in it.  But I still think he's on to something." 

Why is there no money in a cure for cancer that would use a substance that is not patented and costs a couple of dollars a pound?  Asked that way, the question almost answers itself.  On the other hand, if some exotic and patentable chemical was found to do the same thing, it would probably be in clinical trials on humans by now.

The way the pharmaceutical industry in the U. S. and most other industrialized countries works is roughly this.  The firms spend millions of dollars on research directed at finding new drugs.  So far so good.  But not just any new drug:  a new drug that will be at least moderately effective against a malady that requires the drug to be taken indefinitely.  In this way, the company can recoup its investment over the lifetime of the patient as well as the lifetime of the drug's patent. 

Because it is potentially so profitable, this mode of operation has squeezed out other ways that drug companies could work.  If a drug is found that cures a disease with one dose, or if a drug's patent expires and the company can't find a way to extend it, or if a drug turns out to be something that can't be patented in the first place (such as bicarbonate of soda), then the drug companies aren't interested.  And because the companies have become such a dominant force in the research community, drugs and treatments that don't fit their profitability pattern are increasingly ignored and neglected. 

The companies defend their ways of doing things with the claim that modern pharmaceutical research is costly, and if their markets are controlled or supervised with governmental interference, it will be like killing the goose that laid the golden egg.  All drug innovations will cease and we'll be back to using leeches and bloodletting.  That's an exaggeration of their attitudes toward regulation, but only slightly.  And they do have a point:  the business model they have adopted is indeed costly, but when it works, it's extremely profitable and attracts investment capital, without which nothing much could be done, at least in the private sector. 

That is one model of healing.  Another model is that of Mother Teresa.  The famed founder of the Missionaries of Charity dedicated her life and the lives of her nuns to the service of the poorest of the poor in Calcutta, India, and ultimately hundreds of other places around the world.  Their financial system, if you can call it that, would give an accountant nightmares.  They will take donations from anyone—foundations, governments, individuals, even criminals—and spend it right away on the most urgently needed items for the people they serve.  Many of the people they help are dying anyway, but to the dying they bring companionship, hope, and love. 

The work of the Missionaries of Charity has not led directly to the invention of a cure for any disease.  It has not made anyone richer financially.  But it has added to the store of human capital in the form of good works and examples of how to live.

As long as sickness and the other consequences of the Fall of Adam and Eve are with us, there is going to be a tension between these two ways of healing.  In The Abolition of Man, C. S. Lewis portrays a contrast between two ways of approaching the world.  One way is to view nature as simply raw material to be fashioned according to our will or whim.  Another way is to learn from nature what the universe is about, and conform our actions and behavior to what Lewis calls the Tao, the set of perennial principles of right and wrong common to all times and peoples. 

Both the Missionaries of Charity and Big Pharma do good things.  Without the Missionaries, thousands of sufferers in desperate straits would live and die unloved and uncared for.  And without Big Pharma, many medical conditions ranging from the fatal to the trivial would go untreated, and many investors would have to find something else to do with their money.  In the debates about the U. S. Affordable Care Act, experts have proposed many kinds of large-scale plans and changes that would allegedly make things better somehow.  But they are all complicated, because the present way Americans deal with health care—itself a manifold topic of many facets—is complicated, and changing even one aspect of the current system is like pulling on one thread of a spiderweb—the whole thing is likely to be affected.

Historically, sick people have been cared for through a combination of love and money, Mother Teresa's nuns representing the love end of the spectrum and Big Pharma representing the money end.  When the main criterion of a potential cure for a fatal disease is the question of how much money it will earn for investors, we have gone too far toward the money end of the spectrum.  Medical care is a business, but it used to be more than a business—it was a calling.  And unless those involved at all levels of health care perceive the need for love as well as money, things won't get any better in that regard.